PACAM is implementing the following projects in different parts of Malawi.
- * METHOD
- * NAC
- * CPI
Step Up Project
The Meaning of STEP-UP is ‘Service Training Education Prescribing (STEP) Umodzi Palliative Care Model (UP)
STEP-UP is a system strengthening initiative implemented through PACAM. The STEP UP Project Started as a pilot project at QECH in 2011(Phase 1) targeting the southern region of Malawi. Then in 2013-2015 Phase 2 through PACAM. Between August 2015 and June 2017, the Palliative Care Association of Malawi (PACAM) implemented the STEP-UP programme in the Central and Northern regions of Malawi. This followed successful implementation of the programme in the Southern region over the previous four years. From October 2017, PACAM started implementing Phase 4 of the STEP UP Project.
The STEP-UP programme aims to integrate palliative care into publicly funded health services in Malawi by raising awareness about, confidence in and access to palliative care services at district level. It involves providing resources to help district hospitals set aside a dedicated room for palliative care clinics; running awareness raising and training sessions for doctors, nurses, clinical officers, pharmacists, social workers, volunteers, religious leaders and others; facilitating clinical placements to help health workers see good palliative care in action; mentoring district hospitals to ensure their palliative care services are of good quality, and supporting districts and the Ministry of Health to collect information about the impacts of palliative care. The programme is funded by the True Colours Trust.
The overall goal of the STEP-UP programme is to support the provision of sustainable, accessible palliative care services for adults, children and their families through district health services.
Key Learning from STEP UP Phase 3
* Targeting senior officials and frontline teams simultaneously for awareness raising
* Advocating for senior officials to include palliative care into DIP and undertaking sensitization regularly.
* Give them evidence of why PC should be priorities.
* Providing both information and financial resources to pump prime change. Districts are more likely to contribute their own funds.
* Working with both hospitals and community teams to ensure palliative care is embedded at different levels of the health service.
* Seeing a wide range of people as members of the palliative care team, including traditional healers, religious leaders, management teams, doctors, nurses, clinical officers, social workers, health promotion and education officers, data officers and others
* Using data to help show where improvement was needed, by making good use of baseline assessments and tracking changes over time.
* Allocating team members within STEP-UP to have responsibility for collecting data to show progress and keep everyone motivated.
EXPECTED OUT COME FOR STEP UP PHASE 4
- It is anticipated that by the end of the project period, District Health Management Teams shall be committed to prioritizing palliative care services through their district implementation plan and PACAM shall only be there to provide technical support.
- Palliative care services shall be more visible and accessible than before.
- Number of service providers actively practicing palliative care shall increase.
- There shall be improved reporting and data management.
- Number of clinics with dedicated personnel to provide palliative care shall increase.
- Increase the number of children accessing palliative care services at district level.
- Increase awareness in the community about the availability of palliative care services so people start expecting and accessing these services;.
- Encourage districts to initiative follow-up activities themselves using public funding as a way of sustaining the gains made.
EMMS in partnership with Palliative Care Support Trust (PCST), PACAM, Mulanje Mission hospital and Nkhoma mission hospital implemented a three-year project called METHOD (Malawi Education and Training for HIV and Other Diseases - Palliative Care)
EMMS (Edinburgh Medical Mission Services )International is a charity based in Edinburgh, Scotland, working to improve healthcare through partners in Malawi and other Countries.
METHOD project was funded by DFID and other generous UK trusts, including the True Colours Trust.
The METHOD project implementation began in July 2015.
The goal was to increase numbers of people trained and qualified in different aspects of palliative care, at different levels in the health care system and also in areas of legal, social and spiritual work.
METHOD supported College of Medicine to introduce Bachelor of Science degree program in palliative care.
The project trained 128 nurses, 34 clinical officers, 40 Medical Assistants, 39 Pharmacists, 1 doctor and 3 Physiotherapists. The project phased out in June 2018.
THE GENESIS OF CHIFUNDO PROJECT
Considering the need of the services and to sustain the gains of METHOD, anew project has substituted called Chifundo.
Chifundo is Chichewa for “Compassion”. Chifundo is intended to increase numbers of people trained in and delivering various aspects of palliative care (healthcare, social, spiritual and legal work) in hard to reach facilities in all districts of Malawi. The project is 3 years from 6th July 2018 to 30th June 2021.
CHIFUNDO PARTNERS (implementers)
There are 5 key partners (implementers)
- Palliative Care Support Trust (PCST)
- Palliative Care Association of Malawi (PACAM),
- Mulanje Mission Hospital (MMH),
- Nkhoma Mission Hospital (NMH)
- David Gordon Memorial Hospital (DGMH). Other new Partners.
- The 3 Central hospitals. – Mzuzu, Kamuzu and Zomba
- Selected 26 hard to reach health centres through out Malawi.
Hard to reach health centres
Mentorship to APCA palliative care standards level
To conduct 6 Monthly Palliative Care supervision.
To organise 6 Monthly National Palliative Care task-force.
To conduct palliative care audit using APCA standard to 27 participating sites
Advocating for the improved and increased access to pain medication and other essential palliative care medicines to palliative care patients in Malawi.
Title of Grant Project: The goal of this project is to advocate for the improved and increased access to pain medication and other essential palliative care medicines to palliative care patients in Malawi.
In August 2018, Palliative care Association of Malawi (PACAM) went into partnership with Open Society Initiative for southern Africa (OSISA) in implementing a yearlong project to build on the previous project on advocacy “The goal of this project is to advocate for the improved and increased access to pain relief medication and other essential palliative care medicines to palliative care patients in Malawi. The Government of Malawi, with support from PACAM has made significant progress in regards to the integration of palliative care in its health system including policy level, care provider level and the patient and community levels. Despite the milestones realised, Malawi still has challenges for ensuring that all Malawians are able to access palliative care services when they need them. Resource constraints due to competing health priorities are a major challenge, coupled with inadequate public awareness. Logistical (system) and legislative challenges are affecting accessibility of services and essential medicines still exist as well as health worker attitude towards morphine, which is affecting access to pain relief. Some of these challenges can be addressed by ensuring a human rights approach to health services, including access to palliative care essential medicines such as morphine by children and adults who need it and their families. With legal, human rights and policy makers, law makers, law enforcers, health workers, patients, guardians and the general community already sensitized and supportive of palliative care, PACAM have already started working with them and have also formed committees to influence policy review to allow nurses, and medical assistants to prescribe morphine. This therefore serves as a progress report for activities conducted during the period between August 2018 to February 2019.
- Raising awareness about palliative care and palliative care services amongst the general public using human rights approach.
- Supporting the Ministry of Health to ensure adherence to the national palliative care policy and standards at all levels.
- Strengthening the knowledge and skills of individuals and organizations providing palliative care at all levels to ensure access for pain relief and symptom control.
- To advocate for the change of laws on handling and prescribing of essential palliative care medicines such as morphine.